28 February 2007

A moment he wishes he could have back

For once the person doing something just stupid enough to get noticed wasn't me. Unfortunately for the fellow in question, I witnessed the moment and shared my amusement with a number of folks.

Many of you know that there are helicopters staffed with people of spectacular skill and experience (paramedics, nurses, respiratory care folks, sometimes even MDs) ready to fly out and assist patients in dire need. They can be called by even the lowliest EMT-Basic if you have the information to justify the need. What you may not realize unless you're in this field, is that these helicopters not only respond directly to scenes, but also to hospitals where critical patients need to be transported to a higher-level facility. Any interaction I've ever had with flight crews has shown them to be highly professional and strong patient advocates - even to the point of deciding that the patient would be best served not to fly.

The one oft-repeated piece of training to work with them involves landing zone safety. How big it needs to be, what types of obstructions to look for, how far back to clear everything, and how dangerous loose objects can be during takeoff and landing. At one of the hospitals I transport to, the helicopter landing pad is immediately adjacent to the ambulance parking. When the hospital knows the helicopter is coming in, they close off the ambulance parking area to make sure there is enough clearance in all directions. Very inconvenient for ground-based EMTs and their patients, but very safe for the helicopter and staff so the occassional inconvenience is well-tolerated in exchange for the small hype of watching the 'copter come and go. The EMS room has a lovely set of one-way glass with a view of the parking lot and the landing pad, so we have a great view.

Protocol at this particular hospital involves having security meet the helicopter and escort the staff and their myriad of equipment inside the building. I'm not really sure why because I would think the giant "EMERGENCY DEPARTMENT - AMBULANCE ENTRANCE" sign would tell them where to go, but whatever. There is a stretcher in the entryway between the three sets of glass doors which is used to help move the stokes-type basket and all the equipment. This particular day, someone had been useful and covered this stretcher with a sheet. Neatly tucked on all sides, clean, sparkly and ready to go.

Security rolls the stretcher outside just prior to the helicopter coming around the building. He's not really watching the stretcher, which is slowly rolling away from him, but rather fixated on the helicopter. Then, the rotor wash gets serious and that neatly tucked sheet lifts up off the stretcher and heads straight for the sky. Bad, bad, bad - everything should be secured in the area so nothing gets sucked up into the rotors. Security doesn't even see it until the 'copter is all the way down. He turns around to grab the stretcher and notices there is something different here. He spends a few confused seconds looking around and quickly gives up on the mystery of the missing sheet.

After I'm done laughing at his bewildered expression, I head inside the ED to find my medic at the nurses station, which requires a re-telling of why I'm so amused. The nursing staff all lay wagers as to which security guy it was and nobody gets it right, suggesting this was one of a relative few miscues for this fellow. He comes in pulling the sheetless stretcher full of equipment to the patient's room and then disappears. A few minutes later, he comes back, with the sheet. He's laughing because it is a sheet from the hospital across town and he claims it was trying to fly home.

20 February 2007


The quiet here is a result of my complete lack of inspiration to write. I'm waiting out the days until vacation - enjoying them and living fully in them, but not really holding anything in my mind except the vision of me sunning myself near a pool and maybe K splashing around somewhere since he doesn't like to be still.

My interview for med school is between now and vacation, but I'm not sure what I'm supposed to be doing about it. I've done some brainstorming on things I want to highlight when I talk to people, and I had a couple of questions I wanted to ask - but then the school sent me a DVD that answered some of them. I haven't been able to generate much anxiety about the issue since I bought my new suit and new shoes. Apparently my issue was mostly fashion-related. For those who want to know, navy blue with white pin-stripes, a lavender shell, and some 2" navy heels. K encouraged me out of the house to get it done and sat patiently through all the try-ons and debating over color, style, cut and even gave an immediate positive reaction to the final selection. He even went shoe shopping on a search for the "gunmetal gray" shoes the saleslady recommended. I love that man and I rewarded him with steak dinner at a real sit-down restaurant.

I'm sick. I rode with a partner on Friday who was stuffy, sniffling, and so on, and sure enough, come Sunday I felt that little twinge in the back of my throat and by today I'm stuffed and miserable. I almost always get colds that start in my sinuses and drop to my lungs, so by vacation, I'll probably be hacking up a lung every couple of hours.

The office job drags on...nothing new to report.

911 at the ambulance co has been busy lately, but that hasn't involved me much. Saturday morning I missed the truck leaving for a call at 0640 as I was walking in the door for a 0700 start. I wasn't too worried, but I did feel bad after the guy who was supposed to be leaving in the morning didn't get off shift until 0900 because they just kept getting calls before they could make it back to the station. In the end, I hitched a ride with a wheelchair driver and met them at one of the hospitals so he could go home. Also, a fair proportion of my emergency calls lately have been no transport sign-offs where we evaluate people and they decide not to go to the hospital. None of them have been people I worried about after I left the scene, so I think they were all appropriate, but it doesn't give me much to write about.

FD has been slow for night call volume, so nothing to report on the volunteer side either. Town meeting on the budget is coming up right after vacation, so I suppose we'll probably have to go be involved in that lest the tax-cutting enthusiasts decide that we can run the town on even less money than last year.

Anyway, I think you can see the problem. I'll keep trying to find something more interesting, but I don't want to do a lot of posts on what is not going on.

14 February 2007


New Hampshire doesn't really do things half-assed. Today, I do not have a "snow day", I have a "blizzard day". The office job actually closed (first time in the 5 years I've been there) because of the snow. Granted, that location was forecasted for 3" last night, 12-18" during the day today, and another 4-6" tonight. Here at Casa de Jen, we're not supposed to get quite that quantity but our afternoon precip is forecasted as freezing rain and/or sleet before changing back to snow, so we'll have that helpful layer of ice in the middle of the snow.

Here's the decision...I work from home, people who work on-site don't have to work today, so do I work or not? Would I like the day off? Sure. I'm ambulancing it 10h tomorrow, 10 on Friday and 24 on Saturday, so a little leisure today would be nice. Would I feel guilty kicking my feet up on the couch while my computer sits idle in the office? Yup. But I'm thinking getting some work done this morning might just be able to counter that guilt for the afternoon - especially when I'm out shoveling the driveway.

EDITED 20:10: I can conclusively say that I no longer feel guilty for taking the afternoon off, clearly a day with no new email means a day when nobody was workign. 2 40-minute shovelings of the driveway also mean that I have no guilt for not exercising today either!

07 February 2007

Pain scale

I was reading this post today and it got me thinking about my own experiences with the pain scale. When an EMT or hospital person finds that you are complaining of pain in some body area, they will usually ask you "On a scale of 1 to 10, how do you rate your pain?" We all have our own slight variations of how we describe the two ends of the scale (not to mention those non-conformists who like to start the scale at zero). I usually use "with 1 being no pain and 10 being the worst pain you could ever imagine". Usually works for me and if there isn't much I'm doing to treat the patient, it gives me a conversation starter about what people are thinking might be a 10. Morbid maybe, but I haven't encountered anyone who flinched at describing what they thought might be a 10 and it usually segues right into another topic.

We all know that pain is subjective. What seems like a 4 to me might be an 8 to you and that could be a very real difference. Part of the reason we ask though, is to assess whether we need to treat for pain and to get some understanding of severity. I've seen a patient who had lost the tips of two fingers, holding his hand up in the air to help control bleeding, looking pale and pained but otherwise not complaining, rate his pain 8/10 and turn down pain medication. He just thought it wasn't that important and everyone should quit making such a fuss over him. I've seen patients looking completely comfortable tell me their pain is 11/10 and then promptly forget that they're supposed to be in pain if I do a physical exam.

My favorite recently though, was a patient from motor vehicle accident. I got refusal of care forms signed for two people while my partner was assessing and working on extrication with the FD for the other three. I return to the vehicle just in time to get handed a backboarded patient and a FF to assist with loading him in the ambulance. I hop in with him and discover that I've got a very polite, scared, 8 year old boy. He was very attentive and intersted in everything I described to him as I walked him through a set of vitals and describing to me how he was feeling. When I got to the head and neck pain he was having (hence the long board), he'd clearly never been asked before to do this numeric rating. He thought carefully about it and told me 1/10. A little further through the assessment, he mentions chest pain where his shoulder harness on the seatbelt crossed his chest and again tells me 1/10. We got rolling to the hospital and I talked with him and his mother about what happened, who was hurt, the baby in the carseat that was going with us and so on. I kept checking back in with my 8 year old about his pain and he always said it was about the same.

Just before we get to the hospital, I point out that we're almost there and this beautiful boy smiles at me and tells me this was the coolest ride ever. He says it felt just like a roller coaster and he couldn't believe that we got to use the sirens for him. I was extremely happy to check in with them 15-20 minutes after we got to the hospital and see that they'd already cleared his spine so he was off the board and having a great time.

06 February 2007

Mail call

Yesterday was an unusually busy day on a BLS transfer truck, ending with a messed up call that will be a story for another day. I was forty minutes late getting out of work, had a crushing headache, and was thankful that being late at least meant no traffic to deal with. I came in the front door to a smiling K and an excited Watson full of puppy kisses, both happy to see me. I could smell dinner cooking and it was one of those "all is right with the world" moments where I can actually relax and let all my troubles go for a time.

I headed upstairs in full preparation for relaxation mode. Mail is usually on the dining table at our house, so I glanced over to see if there was anything interesting. And there it was. All alone, perfectly straight and neat. Oh crap. From relaxation to full anxiety in 2.2 milliseconds. To me from ABC Medical School, just a letter, one page from the looks of it. In the ordinary college admissions process, letters are bad news, big fat packets of information are good news. Knowing that and the response I got from the last medical school, I'm thinking rejection and steeling myself for the sharp stabbing pain that comes from being told I'm not good enough.

I look at K, "Great day to be rejected, huh?"

"I don't think so. There's a lot of writing on it. It wouldn't take them that long to tell you no." And he confesses to holding it up to the light and trying to see what it said so he knows whether to get into consolation or celebration mode. He couldn't tell, but it makes me smile just to know he tried. I would do the same if the roles were reversed.

"Nah. They wouldn't bother sending just a single page letter for anything good."

"So open it already!"

And under his intense gaze, I did. My face gave something away even as my brain demanded a second reading to be sure. There it was, an invitation to interview. Holy smokes, somebody might want me, somebody thinks I might be good enough to make life and death decisions about the medical care of healthy and sick people.

K is grinning, "Told you so. I told you all along. Have some faith, of course they want you."

The rest of the night was disbelief and anxiety. A couple calls to the family so they could hear it before they read it here. So there it is, an actual interview - I made the initial cut.